Long-term Care

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Current guidelines recommend that women over 40 have mammograms to screen for breast cancer every 1 to 2 years. For elderly women (65 and older) without significant health problems, breast cancer screening every 2 years reduces mortality at reasonable costs, according to a study conducted for the U.S. Preventive Services Task Force. The study was supported in part by the Agency for Healthcare Research and Quality (contracts 290-97-0018 and 290-97-0011).

The researchers reviewed articles published between January 1989 and March 2002 on the cost-effectiveness of screening elderly women for breast cancer. Of the 115 studies identified, 10 met inclusion criteria. Despite methodologic differences among the studies, the cost-effectiveness results were fairly consistent. On average, extending biennial screening to age 75 or 80 years was estimated to cost $34,000 to $88,000 dollars per life-year gained, compared with stopping screening at age 65 years. Two studies suggested that it was more cost effective to target healthy elderly women than those with illnesses that could decrease life expectancy and thus offset the survival benefits of early cancer detection. For example, if a woman has a small breast tumor detected at screening but dies of a heart attack within the next few years, screening had no benefit in extending life expectancy.

These findings are consistent with those of large population-based studies and recommendations of the Task Force. The review identified two areas where further research could help clarify cost-effectiveness: the natural history of breast cancer in older women and the impact of diagnosis and treatment on quality of life. If the preclinical detectable phase of breast cancer is longer in older women (the period when a cancer can be detected by mammography but is still curable), a screening interval longer than every 2 years may be even more cost effective.

More details are in "The cost-effectiveness of screening mammography beyond age 65 years: A systematic review for the U.S. Preventive Services Task Force," by Jeanne Mandelblatt, M.D., M.P.H., Somnath Saha, M.D., M.P.H., Steven Teutsch, M.D., M.P.H., and others in the November 18, 2003, Annals of Internal Medicine 139(10), pp. 835-842.

Editor's Note: Another AHRQ-supported study on a related topic suggests that emotional and social consequences rather than the physical outcomes of positive test results may be more salient in women's decisions to undergo genetic testing for breast cancer risk. For more details, see Vuckovic, N., Harris, E.L., Valanis, B., and Steward, B. (2003). "Consumer knowledge and opinions of genetic testing for breast cancer risk." (AHRQ grant T32 HS00069). American Journal of Obstetrics & Gynecology 189, pp. S48-S53.